Tobacco and Vapes Bill

Richard Graham Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Richard Graham (Gloucester) (Con)]

What a fascinating afternoon of different speeches. As my right hon. Friend the Member for Chelmsford (Vicky Ford) has just indicated, there are two very different ways of approaching the Bill. It is very much a personal matter: tonight’s vote is not whipped, and therefore all of us will have our different perceptions, but I start by saying that we are not all here—as one Member said—to try to prevent restrictions on human activity. I do not see that as the reason I was sent to this House, but surely we were all sent here to try to achieve a better future for the children and grandchildren of our constituents. Once we have all agreed on that, we can discuss whether a ban on children smoking now that will, in time, mean a ban on everyone smoking is a wonderful way of preventing what is not a liberty but an addiction, or whether taking away that freedom is just a slippery slope towards taking away all other freedoms.

Of course, although we cannot measure precisely the future damage of allowing people to carry on as they have been—being able to do themselves considerable damage—we know that the NHS calculates that the current financial cost of smoking is £17 billion a year. For those of us who are also concerned about the size of the state, the use of resources, the productivity of the NHS, and the ability of our constituents to have elective surgery when they want it and to see doctors when they wish to, this is surely a huge opportunity to make a massive difference—not just to future generations’ potential to avoid addiction to tobacco, but to their ability to get the health services that they want at a cost that this country can afford. That is the crux of what we have been discussing today.

It is very interesting to me that all the doctors in the House and all the health professionals in our constituencies—as my neighbour and hon. Friend, the wonderful Member for Stroud (Siobhan Baillie), has highlighted in Gloucestershire—are absolutely united that this is one of the single most important and useful interventions that this House could make. It is a huge credit to this Prime Minister that he has set out a vision with clarity and pursued it with determination, and is absolutely clear that were this House to vote this Bill through, it would be part of whatever legacy he leaves in the future, as a politician keen to make a difference.

I believe the idea that, on the contrary, encouraging worse health outcomes should continue because it somehow benefits people’s freedoms would be a valid one only if the whole business of smoking was harmless and largely cost-free, and we know that that simply is not the case. We have heard the data and the calls: 75,000 GP appointments a month, 690 premature deaths in the Gloucester Royal Hospital alone, and every minute of every day a new patient somewhere in a hospital in the UK because of smoking. We cannot argue that the freedom to smoke and to be addicted comes cost-free, and I cannot imagine opposing a Bill that supports better health and better life outcomes. For the libertarians, it will in fact help to reduce the size and cost of the state. Therefore all these things are fundamentally Conservative goals. In fact, they are not even just Conservative goals, but surely human goals that all of us in this House can share.

In all this, we do not need to think too much about a nanny state—none of us is keen on the phrase “nanny state” or the concept—but how many people here would stand up and vote to take away safety belts in cars, or suggest that everyone could drive motorbikes without a helmet? I believe that what may seem like a slight increase in bureaucracy will, in a few years’ time, be seen as so obvious that we will all be astonished there was any opposition at all. I believe strongly that protecting children, just as we banned children from being chimney sweeps in generations gone by, by banning them from smoking for future generations is exactly what a progressive Conservative Government should do. This Bill, if passed, will be one of the most far-reaching laws that this Government and this Parliament have made. I am absolutely convinced—

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order.

NHS Winter Update

Richard Graham Excerpts

Monday 8th January 2024 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance site of her statement and wish her and the whole House a happy new year.

Unfortunately, the NHS is beginning 2024 the same way it ended 2022—on strike. This week’s industrial action by junior doctors is the longest strike in the history of the NHS at the worst possible time, because even before the strikes this week the NHS was struggling to stay afloat this winter. Hospitals were declaring critical incidents before the strikes. Patients were waiting dangerously long for ambulances and in A&E before the strikes. Ambulances were queueing up outside hospitals for hours to hand over patients before the strikes. The truth is, before the strikes, and before the pandemic, the NHS has been facing winter crisis after winter crisis as a direct result of the Conservatives’ failure—their failure to train enough staff, their failure to arm the health service with modern technology, and their failure to reform.

In January last year, the Prime Minister published an urgent and emergency care recovery plan, promising

“the largest and fastest-ever improvement in emergency waiting times in the NHS’s history”.

Instead, heart attack and stroke victims are waiting even longer for an ambulance, and A&E waiting times are the worst they have been all year. The Prime Minister promised 800 more ambulances, but the Government have now admitted that they are just replacing existing ambulances. He promised that 50,000 patients a month would be treated in virtual wards, but in reality it is fewer than 8,000 patients. Is not the truth that the Conservatives have once again sent the NHS naked into the winter, and patients are paying the price?

Given how ill-equipped the Government left the NHS, and given the desperate pleas from NHS leaders for the strikes to be resolved, why on earth did the Government choose to sit back and let this damaging strike action go ahead? Not only did the Health Secretary allow talks with the junior doctors to collapse and refuse to reopen negotiations until tomorrow, when the damage will have been done; at the 11th hour, as junior doctors stood on the edge of this strike action, she chose to push them straight into it. In what way was it helpful for the Secretary of State, in a series of broadcast interviews, to patronise junior doctors by rebranding them as “doctors in training”? A junior doctor can have 10 years’ experience under their belt; they do not expect to be trolled by Ministers who have been in office for barely 10 minutes.

In the Prime Minister’s interview on the BBC yesterday, we saw why he has allowed the strikes to go on for so long without intervening himself: he is using industrial action as an excuse for the state his party has left the NHS in after 14 years. He would rather blame NHS doctors and nurses than take a shred of responsibility himself. Meanwhile, patients cannot get an appointment, cannot get the surgery they need and cannot see a GP, NHS dentistry is decaying, and the NHS itself is on life support. While he was bragging about all the parts of the NHS that are not currently on strike—that is how low he now sets the bar—he seemed to have forgotten that nurses are still in formal dispute. Is he so uninterested in our nation’s health service that he did not know? Was he trying to pull the wool over the voters’ eyes? Or is he just another Tory Prime Minister asleep at the wheel as he drives the country off a cliff?

There was one thing that the Prime Minister got right in his interview with Laura Kuenssberg yesterday. Whether the question was on the NHS, immigration or the economy, his response was the same: ask the Leader of the Opposition. It seems that even this Conservative Prime Minister knows that if we want serious solutions to the problems facing the country today, there is only one place to look, and that is the Labour party.

[Richard Graham (Gloucester) (Con)]

rose—

[Mr Deputy Speaker]

Order. The hon. Gentleman has been here long enough to know that people do not give way during a statement.

--- Later in debate ---

[Victoria Atkins]

I think the hon. Lady was claiming that there was no winter under Labour, but perhaps that is yet another thing that does not quite stack up. I fully endorse her call for an end to blame culture, but point her to the real and practical measures that we have taken to improve urgent and emergency NHS care. I assume that she joins those on the Government side in condemning the unprecedented strike actions that the junior doctors committee has called at this particular time of year.

[Richard Graham]

Having chaired more than 150 meetings between Gloucestershire MPs and our NHS leaders, this week I am handing over the baton to my neighbour, my hon. Friend the Member for Tewkesbury (Mr Robertson). My two thoughts are, first, to share the Secretary of State’s immense gratitude to everyone in the Gloucestershire Royal Hospital and our other services for all their continuing, amazing work; and secondly, to highlight that the biggest single impediment to reducing the elective surgery backlog—the hips, knees and much more of many of our constituents—is this continued strike by doctors in training. I am sorry, but the continued failure of the shadow Secretary of State to highlight whether he supports patients or strikers shows an absence of leadership. Will my right hon. Friend confirm that the doctors in training, the doctors on strike, have already received, in 2023, a pay rise of between 8.1% and 10.3%?

[Victoria Atkins]

I most certainly can confirm that—those doctors have already received the rise. As I said, I wanted to continue discussions on more fair and reasonable settlements for junior doctors, recognising as I do how tough their job is and the conditions under which they work. May I thank my hon. Friend for the leadership he has shown with his local trusts and clinicians? I agree with him that the one thing we have not heard from the Opposition is that they condemn the strikes. They seem to prioritise union harmony over patient safety.

NHS Winter Pressures

Richard Graham Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

The hon. Lady is right to highlight mental health, which is an extremely important part of the wider health landscape. That is why the Government are increasing funding for mental health by £2.3 billion. We must also consider how we get better value for money from that spending. The reform of the Mental Health Act 1983 that the Minister for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), is taking forward will help us better target that funding in ways that deliver value for money.

[Richard Graham (Gloucester) (Con)]

I join the Secretary of State for Health and Social Care in paying tribute to those working in hospitals, such as the Gloucestershire Royal Hospital in my constituency, so intensely and under such heavy pressure. I welcome the changes that he has announced, but will he confirm what progress his Department has made with the Home Office to prioritise tier 2 health visas and to provide a grace period for international GP trainees? Lastly, will my right hon. Friend consider helping staff with parking and out-of-hours food this winter, which has been described by so many as a perfect storm?

[Steve Barclay]

As I said at the outset, today’s announcement is part of the wider recovery programme that we discussed with health leaders at No. 10 on Saturday. That will have a number of components, one of which is the urgent and emergency care recovery. Work is ongoing with Home Office colleagues on the visa component. My hon. Friend raises an extremely important point that a number of clinicians on the frontline have raised with me, and I am discussing it with my right hon. and learned Friend the Home Secretary.

NHS Dentistry

Richard Graham Excerpts

Thursday 20th October 2022 Commons Chamber

[Richard Graham (Gloucester) (Con)]

This is the first debate for a long time in which I have agreed with every single word of the motion, so I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins). Frankly, we and all our constituents are concerned about the growing crisis in NHS dentistry. We are worried that nine out of 10 practices are not accepting new NHS patients, including large numbers of children. We also regret the number of dentists who are moving away from NHS practice. Those are all issues to which all hon. Members could strongly relate, if they were here.

I have been asking myself how the problem came to be and what can be done. First, it strikes me that there is a wider issue with the delivery of public services. Governments will always be judged on the same things: whether they can achieve economic growth to provide jobs and fund public services; whether they can manage those public services competently; and whether they can do so with compassion so that our most vulnerable constituents are looked after. In the health and care sector as a whole, there is no doubt that there are significant challenges in all three aspects. Dentistry is just one aspect of the effective delivery of public services, an issue that we all recognise from emails and telephone calls with often very frustrated constituents.

However, there is a particular aspect of dentistry that is unique. With acute hospitals, mental health services, ambulance trusts and so on, MPs have some agency: we can organise regular meetings with NHS trusts, hold them to account, ask difficult questions, discuss problems and find out what they need from the Government. With dentistry we have no agency, because the local NHS organisations—they are currently known as integrated care systems, but frankly in most of our constituencies it is easier to refer to them as the local NHS—have no agency. They have no say in the contracts between NHS England and the dentists.

As my hon. Friend the Member for Mole Valley (Sir Paul Beresford) helpfully pointed out, the contracts go back to 2006. Most of us have no idea what is in them. I have never seen them; I was not aware of them. No dental association, nationally or locally, has ever contacted me—or, I suspect, many of us—to say that there is a problem that needs to be resolved or to ask for help. The first we hear of it is when constituents contact us to say, “I cannot get an NHS dental appointment for myself, my children or my family.” At that stage, we go back to the local dentists and ask what the problem is.

This is what a local dentist in Gloucester has come back with:

“The majority of dentists move away from the NHS because of the continual pressures that the NHS contract places upon them in terms of requirements, payments, audits…and many other factors”.

She writes that an NHS dentist in her surgery, who has ceased to be an NHS dentist,

“was under a prototype contract that was patient-centric and when this was discontinued and changed to align with the usual NHS contract, the dentist did not feel this gave the best type of care for patients”.

She goes on to say:

“I’ve continually battled”—

she has been doing this for 25 years, by the way—

“to ensure that any patients who want NHS dental services should be able to access them, but there needs to be correct remuneration for the time and quality of services, removing a treadmill of patient care.”

That suggests that there is a problem with the contract, as my hon. Friend the Member for Waveney rightly says, as well as the problem of there being no local NHS involvement.

I welcome the Minister to his role. I know that he will bring to it the same quality of analysis and compassion that he brought to his role in the Department for Work and Pensions. I hope that he will look closely at how the contracts can and should be changed—I believe that there is a window of opportunity in April—to allow all local NHS organisations to play a key role in the distribution of resources, emphasis, recruitment and so on. We will then finally have some agency, so we can do better than replying to our constituents with “I am very sorry to hear this, but there is absolutely nothing I can do,” which frankly is more or less the situation at the moment.

Several colleagues have helpfully indicated solutions beyond the contract. I agree with the point about making it far easier for dentists, whether they come from the nations of the Commonwealth, such as New Zealand and Australia—mentioned by my hon. Friend the Member for Mole Valley—or from India or Hong Kong, which is another example that was given earlier. The Government clearly have an opportunity to do something about this if they wish, not just in the short term but in the longer term, and I hope the Minister will give us some good news in that regard.

There is also the issue of skills and training. Setting up a new dental school, first, takes time; secondly, is expensive; and thirdly, will not solve short-term problems, although we do need to look at capacity for the longer term. There is a continuing problem with longer-term thinking—in the context of public services, and indeed in other contexts—to which all Governments have been susceptible for too long.

The private sector certainly has a role to play. At the risk of plugging a particular organisation, I will mention an organisation of which I think the Minister will be aware: Genix, which has a training facility in Leeds. Its founder and CEO, Mustafa Mohammed, has a strong track record of supporting the whole business of upskilling and training dentists and providing NHS dentistry services around the country. Let me reassure my constituents and others who feel that dentistry is an entirely public-sector activity by saying that just as the private sector, through GP surgeries, plays such an important part in, for example, the delivery of covid vaccinations, it can play an important part in dentistry as well.

There is, in fact, a role for a mixed economy, and, as was pointed out earlier, there is an opportunity for some short-term contracts. Perhaps the Department could step in directly, with NHS England, to provide relief for those in pain and for those with children who may never have seen a dentist in their short lives. I am sure we would all welcome that.

That leads me to the question of what some term the nanny state—the role of education and proselytising about the value, particularly for young families, of getting stuck in with toothpaste and toothbrushes, and, perhaps, the opportunity to relieve them of VAT. We know that, just as with education, if things start well there is a strong likelihood that they will continue well, whereas if they start badly and people’s teeth do not get the treatment they need at an early stage, there will be problems later. I believe that the Government have an opportunity to play a part in this, although not uniquely, for everyone can play a part; and I hope the Minister will allude to that as well when he winds up the debate.

Let me finally say that dentistry clearly needs to be represented in local NHS bodies—especially if they are actually going to play a role in it, which I very much hope they will—and that cash will be crucial. Nothing comes cheaply, but I think we can all agree that sorting out dentistry and making sure everyone has access to NHS dentists is a very precious cause, and we all hope we will find solutions fast.

--- Later in debate ---

[Jane Hunt (Loughborough) (Con)]

I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) on securing what is clearly an important debate.

I take this opportunity to thank those in the dental profession in Loughborough and across Leicestershire for everything they have done over the past few years and particularly for the way they adapted to implement the huge changes needed to ensure the safety of their patients throughout the covid-19 pandemic. This year I have met with nearly all the dentists in my constituency, who have highlighted a number of issues they face and the impact they have on the profession and the patient experience more broadly.

[Richard Graham]

The points my hon. Friend is making are particularly important to constituencies such as hers, which have towns but are also rural.

[Jane Hunt]

I thank my hon. Friend, who is a true hero in every way.

One concern is about the UDA system, with the recurring message being that the system in its current form is not fit for purpose. I welcome the package of initial reforms to the NHS dental contract announced in July, in particular the introduction of enhanced UDAs to support higher-needs patients.

However, the reforms do not address my local dentists’ concerns that the current system is based on rewarding reactive treatment, rather than preventive, meaning that dentists are driven to do the minimum necessary to meet the terms of the target. That is a source of frustration for some, who have expressed their preference for being remunerated for using their initiative and working in the best interests of their patients.

Furthermore, while it is welcome that a minimum indicative UDA value of £23 has been introduced, UDA payments are not rising in line with increasing overhead costs, which is devaluing contracts and, in some cases, leaving dentists out of pocket. That was highlighted recently during a conversation I had with Bupa in Loughborough. Bupa expressed that that is compounded by the fact that UDA payments vary geographically, so that a UDA is worth £36 in its Sheffield practices but only £24 in its Loughborough one. Finally, the reforms do not address the issue of dentists not being given leeway under their contracts for last-minute cancellations and no-shows, even though they can lead to missed targets. I ask that this be urgently reviewed, so that we do not punish dentists for trying their hardest to continue to provide the care needed.

It is clear that there is still a way to go to make NHS dental contracts more attractive, both in terms of the nature of the dentistry performed and the level of financial reimbursement received for services performed. I fear that if the Government do not continue to work at speed, we will lose even more NHS dentists through early retirement, a reduction in time spent completing NHS work, or a full move into private practice. That would be detrimental to patient care and the availability of NHS appointments. I know that the former Minister of State for Health, my hon. Friend the Member for Lewes (Maria Caulfield), was working hard to review UDA contracts, and I would welcome confirmation from her successor that they will continue that hard work.

As well as difficulties retaining dentists, I have been informed that locally, we are having difficulties recruiting them. One reason for that is that there is no dentistry school in the east midlands, our nearest being in Sheffield and Birmingham, and students are choosing to enter into the workplace close to where they study. That is causing supply issues in the NHS service, and has created a gap in the market that is being filled by private dentists with a focus on cosmetics. We therefore need to ensure we are training up enough dentists and providing them with incentives to move away from where they are studying to areas with greater demand. Bupa has also advocated for putting dental practitioners on the shortage occupation list in order to increase overseas recruitment and fill shortages, then upskilling those practitioners via short courses to meet UK standards. Could the Minister please comment on the actions being taken to increase the number of dentists from overseas?

I am very concerned that NHS England has proposed closing the intermediate minor oral surgery service in Loughborough, meaning that local residents will have to go as far as Leicester for treatment. That city is some considerable way away, and there has been a recent cut in bus services, the No. 2 bus service in particular. Loughborough is effectively Leicestershire’s county town, so there is more than enough demand there for that service. Closing the centre will only increase pressures on the Leicester centre, extending waiting times and further impacting on patient care. That centralisation of services does not meet the needs of the patient, and I ask that the Minister look with some urgency at local services’ availability throughout the country, especially throughout Leicestershire.

Having listened to the whole of today’s debate, it has been very interesting: there are a small number of points that need to be addressed, which have been made by Members from all across the Chamber and all over the country. I do not think this is an insurmountable problem to solve, and I feel sure that the Minister will be able to address it.

--- Later in debate ---

[The Minister of State, Department of Health and Social Care (Will Quince)]

I thank the hon. Member for Denton and Reddish (Andrew Gwynne) for his kind words. He will be pleased to know that, despite what he said, I scribbled my own speech today and I can confirm that it will be a fudge-free zone. In fact, I have not had any fudge for about three years and I do not intend to start now—not least because it would not be great for my teeth.

I congratulate my hon. Friend the Member for Waveney (Peter Aldous) and the hon. Member for Bradford South (Judith Cummins) on securing time for this hugely important debate. I thank the Backbench Business Committee for allowing the time and all right hon. and hon. Members who have made constructive contributions to the debate. It would be remiss of me not to thank all those who work in NHS dentistry, not just for their work throughout the pandemic, but for the work that they continue to do serving people up and down the country.

In the relatively short time that I have available—I am conscious that there is another important debate to follow—I will endeavour to respond to as many of the points, themes and questions raised as possible. I hope that right hon. and hon. Members know me well enough already, however, to know that my door is always open. I have never turned down a meeting with a parliamentary colleague and I do not intend to start now. This is an important issue and I hope that we can continue to talk about it at length, even if not in this Chamber.

As the new Minister—or new new Minister—for primary care and therefore dentistry, I have spent the first few weeks in post learning more about NHS dentistry, including by meeting dentists; meeting people at the coalface and the grassroots is really important. Of course, I have my constituency experience too. Despite the events of today, I very much hope to be here for some time to come.



Let me say at the outset, in response to I think nearly all of the contributions made today, that I get it—I really do get it. I know that in many parts of our country access to NHS dentistry is difficult or far more difficult than it should be, and I want to make it clear that dentistry is an incredibly important part of the NHS. The Government and I are committed to addressing the challenges that NHS dentistry continues to face across the whole country, and as the hon. Member for Denton and Reddish rightly pointed out, it is in our ABCD strategy.

I turn to some of the themes raised. The first is access, which was raised by my hon. Friend the Member for Waveney, the right hon. Member for Knowsley (Sir George Howarth), my hon. Friends the Members for Mole Valley (Sir Paul Beresford), for Gloucester (Richard Graham) and for Salisbury (John Glen), the hon. Member for Bootle (Peter Dowd) and my hon. Friend the Member for North Devon (Selaine Saxby). Access to NHS dentistry varies across the country—we know that—and it was an issue, as the hon. Member for Denton and Reddish rightly pointed out, even before the pandemic, but the pandemic has exacerbated it and added further pressure to the system.

The Government are taking a number of important steps that will improve dental access for patients and make NHS dentistry a more attractive place for dentists and their teams to work in. I will outline just some of those. These changes include improvements to the current NHS dental contracts—I will come on to that in a moment—and of course to the recruitment and retention of dental professionals. I say dental professionals specifically because this is of course about far more than just dentists, as important as they are. As the hon. Member for Denton and Reddish pointed out, rightly, we have seen an additional 539 more dentists returning to NHS dentistry last year, which of course means they are able to treat more patients, but I recognise the point he rightly made, and we do need to go further and faster.

On the steps taken, notwithstanding the points made by the hon. Member for Bradford South, we made £50 million of extra funding available for NHS dental services at the end of 2021-22, which provided more appointments and increased capacity in NHS dental teams. I noted her points, and we have learned from that. Given that experience, I would certainly want to do things a little differently if we considered such a proposal again. We announced a package of improvements to the NHS dental system on 19 July, as a number of Members have pointed out, which was set out in our plan for patients. These are an important first step to system reform and are designed to improve access to dental care for patients, particularly patients with the most complex treatment needs.

A number of hon. Members raised the much criticised—and that is as far as I will go, the hon. Member for Denton and Reddish will be pleased to know—2006 contract. We are making improvements to ensure that dentists are more fairly remunerated, especially for more complex oral health needs. The one example we hear very often is of dentists getting paid the same for doing one filling as for six fillings. As numerous hon. Members have pointed out, we have also set a £23 minimum UDA value, notwithstanding the points made about the variation around the country.

My hon. Friend the Member for Gloucester raised accountability locally, including to Members of Parliament. In part the answer to that is their coming within the remit and purview of integrated care systems. I have no doubt that my hon. Friend is well aware of the chief executive of his integrated care system, and will know how to contact and meet them on a regular basis.

[Richard Graham]

The Minister is absolutely right: not only do we know the chief executive, but all Gloucestershire MPs have had regular meetings with them, including one specifically on this issue. That is why I raised the importance of their being given the opportunity to take responsibility, which I hope my hon. Friend will welcome.

[Will Quince]

I certainly do welcome that, because this is not just about commissioning, but about accountability and oversight.

Our changes will allow NHS commissioners to have more flexibility in commissioning, and I think that is really important, because if they have that flexibility in commissioning additional dental services, they are the ones who know the local need within their area. I want to see far more responsive management of contracts, so if they have underperforming practices and practices that can do more, we should enable such practices to do that. For example, a high-performing practice should be able to deliver beyond its existing contract to make up for the fact that a neighbouring practice is not doing so. That addresses some of the points made by my hon. Friend the Member for Waveney about the clawback of UDA funding at the end of the year, and then its not necessarily being spent on dentistry. As part of that, I also want and expect more transparency. We will make it a requirement for NHS dentists to update the information on their NHS website, so people can see which dentists are accepting new NHS patients for treatment.

On that point, I want to bust the myth about being registered with a dentist. There is no such thing as being registered with a dentist or a dental list. People approach an NHS dentist for specific treatment. They go on their list, register and have the treatment. They can have an ongoing relationship with a dentist, but anyone can book an appointment with any dentist with an NHS contract, regardless of where they live in the country. It is important to get that message out, because when our constituents say to us, “I can’t get a dentist locally”—I want to address that point—I want to ensure that they know that they could travel to a neighbouring town or city. They could travel half way across the country if they wanted to, for example if they had relatives there, if there was a NHS dentist who had capacity to see them.

Health and Social Care Leadership Review

Richard Graham Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

I agree with my hon. Friend: that recommendation for a standard appraisal system, which, remarkably, does not exist at the moment, is of particular importance, like all of the recommendations. I agree with the emphasis he puts on that.

[Richard Graham (Gloucester) (Con)]

The focus that the Health Secretary is giving to leadership management training must be right. We all know that in a Care Quality Commission report on a hospital or an Ofsted report on a school, one of the key differences between adequate and outstanding is the quality of leadership. All credit to the report for focusing on that; I think we would all benefit from understanding that it is one of the key characteristics of hospitals whose internal staff surveys show strongly positive morale—often a key leading indicator.

Will the Secretary of State say a word or two about the point raised by the hon. Member for Easington (Grahame Morris)? The report and what has come out of the North East Ambulance Service are truly shocking and highlight what I think Sir Gordon Messenger called a need for a change of culture. How can we encourage all our NHS trusts to be open and transparent about what has gone wrong, so that we do not have future scandals like that?

[Sajid Javid]

My hon. Friend will see when he has had the opportunity to read the report in full that it does rightly talk about the importance of that particular issue: ensuring that people within the NHS and care feel comfortable coming forward when they see wrongdoing, so that we can act much more quickly. That is why we will be implementing all the recommendations. Regarding the North East Ambulance Service, I hope he heard what I said earlier about the need to look at that again very carefully.

Health and Care Bill

Richard Graham Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Matt Warman (Boston and Skegness) (Con)]

When I spoke on workforce issues on this Bill last time, I said I was prepared to support the Government’s position on the basis of what the Minister and the Secretary of State had said. The Whips do not need to worry too much, because that remains the case, but I feel a huge amount of sympathy for my right hon. Friend the Member for South West Surrey (Jeremy Hunt) and Lords amendment 29B. Fundamentally, if the Government are not prepared to accept what the House of Lords has proposed, they are making their relationship with NHS staff and those associated with the NHS somewhat more difficult.

I ask the Minister to ensure that he doubles down on the commitment he made previously to engage relentlessly, publicly and as extensively as possible with that workforce. If the Government do not do that, there will never be that sense that the cavalry is coming over the hill.

When my right hon. Friend the Member for South West Surrey was Secretary of State, we established a new medical school in Lincoln—a huge achievement of his, and one I continue to try to take as much credit for as possible. However, saying to doctors in my local constituency, who are working so hard at the Pilgrim Hospital in Boston and in Skegness, that we are recruiting more people locally who will be able to make a difference is a challenge, because they do not yet see it on the wards. Part of that, as has been said, is because it takes such a long time to train people and bring them to fruition.

[Richard Graham (Gloucester) (Con)]

A number of us have been successfully lobbied by the Royal College of Nursing in our own constituencies, showing us the figures—a shortage of 250 nurses in our A&E at the hospital in Gloucester—and staff surveys showing that morale is not where it should be. Does he agree that those things are influencing why some of us are not happy with the Government’s position?

[Matt Warman]

I agree that the Government need to continue to address that issue in the way I have described, through more extensive engagement to try to demonstrate some of what is happening.

That brings me to my second point—I will try to stick to the original time limit—which is that these issues are about trust. We need trust with the NHS workforce. As my right hon. Friend the Member for West Suffolk (Matt Hancock) said, with reconfiguration it is very often the case, as it is in my constituency, that even though the data says we will save lives by moving a service from Boston to Lincoln or vice versa, we need to engage with local communities, because right now they simply do not believe that a service that is further away may yet save lives. That does not ring true, and often the data is not yet there.

I simply appeal to my hon. Friend the Minister to deliver on what he said at the Dispatch Box about engaging with the profession, because that is essential to try to improve the morale that the pandemic has damaged so much. I also appeal to him to ensure that local NHS organisations engage with local people, because only that will win public support for the reconfiguration that is so essential for our NHS both locally and nationally.

Public Health

Richard Graham Excerpts

Tuesday 14th December 2021 Commons Chamber

[Sajid Javid]

I must make some progress, but I will take further interventions in a moment. I wish to talk about the importance of what we have learned about omicron and the vaccines. Vaccines have proven to be highly effective against previous variants, such as the alpha and delta variants. That has weakened the link between cases, and hospitalisations and deaths, and it has allowed us to reopen our country once more. But recent analysis from the UK Health Security Agency has shown that two doses of a vaccine provide much lower levels of protection against symptomatic infection from omicron when compared with the delta variant. More encouragingly, effectiveness rose considerably in the early period after a booster dose, providing about 70% to 75% protection against symptomatic infection. This data starkly shows the importance of booster doses and why we are working so hard to get many more boosters into arms. I will say more about that in just a moment. Our strategy is to take proportionate action now, to come down hard on this virus and strengthen our defences, rather than waiting until it is too late.

[Richard Graham (Gloucester) (Con)]

Surely the whole point is that we cannot be complacent and assume that this likely huge increase in infections is all going to result in very mild symptoms. What the Government are doing, therefore, is taking modest steps to ensure that if that does not happen, we will be prepared. Will he promise that if this situation does not materialise, he will be able to relax again?

[Sajid Javid]

We all want to relax. I wish I was more relaxed now than I already am. My hon. Friend is absolutely right on that, and I agree with him.

--- Later in debate ---

[Richard Graham (Gloucester) (Con)]

It is a pleasure to follow my hon. Friend the Member for Totnes (Anthony Mangnall), although I will not, alas, agree with every word he has said. Let me start by celebrating some of the things that I think we can all agree on, such as the end of the red list for all 11 countries and the extension of the travel passes for all teenagers. I think many of us can agree that we need to release from quarantine immediately those who are still in quarantine in our country having come from those red list countries.

Today, we vote on four specific measures. First, we have a modest increase in mask wearing, which really can only be opposed by those who strongly oppose it on principle. Secondly, we have an end to the pingdemic of self-isolation in favour of lateral flow tests, which surely everybody can agree is a step forward. Thirdly, we will vote on having mandatory vaccination for NHS workers, which the NHS itself supports. Lastly comes the issue for debate, which I would say is a modest requirement for a lateral flow test to go to venues with more than 500 indoors and 4,000 outdoors. In my constituency, that amounts to Gloucester Rugby, Gloucester cathedral and the ATIK nightclub, and I believe that all of those will be quite capable of administering things effectively.

What is it that the libertarians, led by the eternal cavalier my right hon. Friend the Member for New Forest West (Sir Desmond Swayne), most object to? I believe that they object in principle to new rules being introduced, and struggle slightly with the specifics of what is wrong with the proposals brought forward today. Let us be clear that there is no vaccine passport, nor is this Nazi Germany in any conceivable shape. They are scaremongering, for everybody accepts that the omicron variant rate of infection is moving fast. We cannot be sure how many with omicron will need to be hospitalised, so we cannot wait to do something until the Gloucester Royal and other hospitals are overflowing with people with covid and critical cancer operations have to be cancelled. I do not believe any Member would want to face the family of someone lost because a cancer operation had to be cancelled as a result of the hospital being clogged up with omicron variant covid sufferers.

Is everything perfect? No. I have three suggestions for the Minister and the Departments involved this evening. First, they need to reassure us on the provision of lateral flow tests. We must have them, otherwise people will not be able to get them and fulfil the requirements of these rules. Secondly, we need to look again at the wording on the advisory recommendation that people should:

“Work from home if you can”.

I believe this should be, “Work from home if you wish”. Thirdly and most importantly, the impact assessment makes it clear that the central estimate is that 73,000 NHS workers out of 1.8 million do not want to be vaccinated, and we need to do more about that.

Covid-19 Update

Richard Graham Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

Yes, I agree wholeheartedly. Over the past hour or so we have, understandably, talked a lot about the importance of the booster programme, but it is still hugely important that we continue to focus on those that currently remain unvaccinated.

[Richard Graham (Gloucester) (Con)]

I welcome the news that a daily lateral flow test will replace self-isolation for those in contact with a covid case. I welcome the extension of the travel pass to 12 to 15-year-olds. I especially welcome the Secretary of State’s confirmation that a lateral flow test is the clear alternative to being jabbed for access to any venue and any event, so there is no reason for anyone to contact us asking us to vote against a “vaccine passport”. What would he say to those who have recently had covid, been told by the NHS that they should not have a PCR test for three months and then need to travel abroad for work purposes? What should they say when asked for proof of a negative PCR test?

[Sajid Javid]

I very much agree with my hon. Friend’s first remarks. This House is not being presented with a vaccine passport. That is not on the table. It is not in any regulation. The Government have been absolutely clear that when we talk about access to nightclubs or large and very large gatherings—very targeted events—the requirement is to take a free lateral flow test and make sure it is negative. If people do not want to do that, they can prove their vaccine status. It is up to that individual. That is what it is. It is not a vaccine passport, and the sooner we get rid of that misleading description of what the Government are proposing, the better. On the question that my hon. Friend has asked, I want to ensure I get the answer right, so if he will allow me, I will look into that and get back directly to him.

Health and Care Bill

Richard Graham Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

I have accompanied nurses to Downing Street to deliver a petition calling for the cancer workforce fund. I have spent time with Miriam Dibba Demba, a specialist gynaecology, oncology clinical nurse at St Bartholomew’s Hospital, and Eamon O’Reilly, a Macmillan lead nurse for cancer and chemotherapy at the Chelsea and Westminster Hospital NHS Foundation Trust. That is when we know that something has to change for the future, because the care and support that cancer nurses provide has been a lifeline for so many living with cancer. I urge the Government to put in place the funding to ensure that this essential support can continue.

[Richard Graham (Gloucester) (Con)]

I rise to speak on amendment 10. I want to start by relaying a conversation that I had soon after being elected 11 years ago in Gloucester. I talked to the chief executive of a hospital trust—he has subsequently moved on—and asked him how many nurses a year we needed to replace those who have retired and resigned, and to cope with increasing demand, not just in the hospital trust but including district nurses and nurses to cover the whole panoply of our needs in the county of Gloucestershire. He explained that we needed roughly 400 a year at that time. I asked him how many we were training. He said that the University of the West of England trains around 120 graduates a year from its nursing outlet in Gloucester. How do we meet the gap, I asked, and he said, “Well, we advertise. We try to encourage people from London to look for a change in their lifestyle and we recruit from abroad.” I asked him where that got us to. He said, “Well, it increases the numbers, but it never gets us enough. We struggle with a permanent shortfall of recruitment.”

Over the next few years, I worked on three things. The first was to support the Government push to create nursing associates. The second was to encourage the University of Gloucestershire to become a nursing teaching university and to submit an application to get pilot project status for the nursing associates’ training. Both of those came to pass. They were a credit to the Government, a credit to the university and a credit to the Nursing and Midwifery Council that supported them. None the less, we were, and are, still short; that gap has not been closed.

One other thing that I have done recently is to support the close engagement with the Government of the Philippines, who have kindly allowed us to carry on recruiting nurses from the Philippines to the United Kingdom during the pandemic. I ask everyone here to join me in paying tribute to the roughly 35,000 nurses from the Philippines who have made such a difference to our NHS. All those things have helped, but anyone who has played the role that all of us in this House have over the past two years will know that the people problem is the greatest problem that we have.

I chaired, first every week and now every two or three weeks, a meeting between all the MPs in Gloucestershire, the heads of the NHS trusts, public health and the county council. Time and again, the same issue comes up in a slightly different way: it is about people. Yes, we could build extra wards. Yes, we could convert offices into wards. Yes, we could build bed capacity, but we do not have more people to look after the patients in them. Yes, we have plenty of spaces in care homes, but we need to be able to send people back to their home from hospital, because that is how they recover best, and we do not have enough domiciliary care workers.

We have gone round and round for the past 10 or 11 years on this issue of staff—doctors in primary care surgeries, nurses everywhere and domiciliary care workers. I do not believe that we can resolve this problem until we start planning for the needs in different parts of the country and then working out how we can provide the training, the skills and the recruitment of individuals to make that happen. Of course it will not be perfect. Of course disasters such as the pandemic will make a bad situation much worse. We recognise that, but until we start that process, I do not believe that things will change. For as long as I am MP for Gloucester, I am absolutely certain that I will be having the same conversations about human resources—the people who deliver the care and health that all the people in my constituency and across the county and country need and deserve. It is not the best use of MPs’ time to constantly have to sit down with our health professionals in local NHS trusts to work out how we are going to mind the gap. That whole process has to be started from higher up, in the Department of Health and Social Care.

Today, we have an amendment that has enormous support not just from the Select Committee that my right hon. Friend the Member for South West Surrey (Jeremy Hunt) chairs, but from outside this House from the royal colleges, the NHS trusts and many others beside. I am frustrated that the Government have so far not indicated whether they will accept the amendment. In their hearts, the Minister and his colleagues, all good people trying to do their best, recognise that this problem will have to be tackled. Perhaps part of the solution will be in the White Paper that we are all so eagerly waiting for and that we wish that we had been able to have a few days ago, before the votes last night, on which I supported the Government on the basis of trust. None the less, there comes a time when we have to say and vote for what we believe in. I do believe that we need this change and that the Government can and should do it, and I will vote for it.

[Mr Kevan Jones (North Durham) (Lab)]

I rise to support new clause 1, which stands in the name of the right hon. Member for Romsey and Southampton North (Caroline Nokes), myself and 18 other right hon. and hon. Members from across the House. I first took an interest in this subject through a constituent, Dawn Knight, from Tanfield in my constituency. Dawn raised issues around the cosmetic surgery industry having been a victim of a particular hospital group. She has been a tireless campaigner in ensuring not only that victims get a voice, but that we press for more regulation.

I join others in paying tribute to the all-party group on beauty, aesthetics and wellbeing for its recent report and to my hon. Friends the Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins) for their work on that report, which highlights what my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) called the “wild west”. That is exactly what it is: it is a wild west without any regulation. It is a multibillion-pound industry, which is not only putting people at risk, but costing the NHS money.

In April 2013, the Health Secretary at the time—Andrew Lansley, now Lord Lansley—commissioned Sir Bruce Keogh to carry out a review of the regulation of cosmetic surgery. The review came out not only when we were having problems in the sector itself, but when interest was heightened around Poly Implant Prothèse breast implants, which people will well remember. When the review concluded, it explicitly advised the Government to increase regulation of the cosmetic surgery industry to prevent unlicensed treatments and increase patient safety. The review stated that a person having a non-surgical procedure

“has no more protection and redress than someone buying a ballpoint pen or a toothbrush”,

and

“dermal fillers are a crisis waiting to happen.”

As the right hon. Member for Romsey and Southampton North said, that crisis has actually happened already.

I have been campaigning on this issue for a number of years, during which time I have gone through a succession of Health Ministers, all of whom have come back with two points. The first is, “We are going to implement the Keogh recommendations”. But because Ministers were too terrified previously to make any health legislation, they were reluctant to bring those recommendations forward in that way.

The only good news in the area has been private Member’s Bill of the hon. Member for Sevenoaks (Laura Trott), the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021. That legislation was tightly focused—as all private Member’s Bill have to be—and banned botox injections for under-18s. I congratulate the hon. Member on that work. However, any other regulations have been left unfinished. I have sheaves of letters from former Health Ministers saying, “The Keogh recommendations will be implemented”, but they have not been to date. If we do not do that in this Bill, when will it be done? I doubt that the Department will come forward with a Bill just to implement those recommendations; that is wishful thinking.

There is clearly no regulatory framework in the UK at present for those performing aesthetic non-surgical cosmetic treatments. The area is completely unregulated and lacks any national standards. There is no consumer protection, education, training or qualifications for those administering such treatments. As my hon. Friend the Member for Brent Central (Dawn Butler) said, some people call themselves nurses with no qualifications whatever. There is a huge discrepancy between the standards and qualifications of the training of these people. The other side of the issue, to which I will turn in a minute, is the regulated system, which, frankly, is failing as well.

The right hon. Member for Romsey and Southampton North raised the issue of training. If hon. Members visit any website tonight, they will see huge adverts saying, “Become a dermal filler specialist: training and qualification online within half an hour”—even less time in some cases. The people offering such services have no qualifications whatever, because the qualifications are not worth the paper that they are written on, but these people start carrying out invasive procedures without anybody stopping them. They can do it in a kitchen, or in any area that has not been clinically cleaned and is not of a standard that we would expect for medical procedures. It is a multimillion-pound racket that includes both the people offering the training and those carrying out procedures. It is an increasing issue, which needs to be addressed.

We also need to address the issue of advertising. As I have said before in the House, the Advertising Standards Authority is frankly a complete waste of time. If hon. Members go on any website tonight, or even open the national newspapers, they will see people advertising these services—potentially dangerous procedures—without any qualifications. We might ask, “Why would people have these procedures?” Well, I suggest that everyone reads the Mental Health Foundation’s 2019 report on body image, which shows the increasing pressure on young people.

The right hon. Member for Romsey and Southampton North is correct that this issue mainly affects young women, but it is increasingly an issue for some young men. The pressure of factors such as advertising and photo enhancements lead people to think that there is the perfect individual, but—apart from you, Mr Deputy Speaker—I am not sure that there is. The foundation’s reports highlights the pressure that is put on young people, but particularly young women. If they look at prices for procedures, they end up going to people who are completely unqualified. It is a scandal that there is no legislation to prevent this.

Covid-19 Update

Richard Graham Excerpts

Thursday 22nd July 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for the hon. Member’s questions. She knows—she and I discussed this on Friday morning—that there is OCTAVE and OCTAVE DUO as well. I know that OCTAVE is to report imminently, and I will share that data with colleagues on our group even when the House is in recess. I will make sure that happens as soon as we receive that data. We want to make sure that people are protected. There was some very encouraging data from Public Health England on the immuno-compromised, with 74% production for some, not all, after two doses, but the hon. Member is quite right to point this out. We will look to vaccinate and protect them with a third dose—a booster dose—as the top of group 1 in phase 1 in September.

[Richard Graham (Gloucester) (Con) [V]]

Nobody underestimates the huge challenges the Government face or the great success of the vaccination programme, but does the Minister recognise the frustration of the many hundreds of thousands who have been double-dosed but are pinged and self-isolating—following the guidelines— when they learn of the data suggesting how many people are turning off or deleting the NHS app, with Ministers reportedly advising businesses that this is only guidance? Does he not share my view that surely what is right on 16 August for the double-dosed is right now? Will he agree to consider implementing the measure as soon as possible so that businesses do not have to close, the hospitality sector does not suffer, and many of us do not self-isolate unnecessarily?

[Nadhim Zahawi]

My hon. Friend makes a very powerful point that he has made to me many times. It is important clinical guidance to people. It is important that people take personal and corporate responsibility, as we are seeing with some great companies, such as Lidl, which are coming under pressure at the moment because staff are having to self-isolate. As I said earlier, there are no easy decisions on this, but to be able to transition the virus from pandemic to endemic, we just need that careful, little bit more time until 16 August—it is not long to go—when everyone who is double-dosed will not have to self-isolate for 10 days.